The experiences you have as a child are among the most important in your lifetime. They can change the way you perceive yourself and the world around you – for better or for worse. I was many things as a child – Inquisitive, affectionate, and kind. I didn’t have too many issues with paying attention or not getting along with my peers. However, while I was usually described as “a joy to have in class” by my elementary school teachers, which usually just meant that I was quiet and non-disruptive, no one seemed to notice the intense anxiety lurking deep within me. I was anxious about almost everything around me, and it was all primarily due to a traumatic experience that happened early in my childhood.
Unfortunately for myself and many others, anxiety has been a large part of my life for as long as I can remember. Everything seemed to make me nervous – I remember a period when I began asking my parents religiously as they tucked me into bed every night, “Where will you be while I sleep?” It wasn’t that I was afraid they would abandon me. Instead, I was almost always afraid that something bad was going to happen, and needed to know where to go, just in case. Most of the time, “something bad” was a health emergency. While I had no serious health complications at the time, my mind still convinced me that the threat was very real.
Health anxiety can vary in severity. It can be an annoyance, or it can be debilitating and take over your life. “Severe health anxiety, the extreme end of a continuum of health anxiety, is often termed hypochondriasis.” (Rachman, 2012, p. 502) I wouldn’t call myself a hypochondriac anymore, however at my anxiety’s peak I’d say I was pretty close. Either way, the general symptoms are easy to spot if you know what to look for. For me, they began to present themselves in my early childhood – the most obvious to others being the need for almost constant reassurance. It was as if I had to make sure everything inside me was working perfectly, otherwise I would somehow self-destruct. Similar to the scenario I mentioned above, I would constantly ask my parents if something I noticed about my body was normal or not. Everything from a slight pain in my chest, a headache, or even a new mole I had developed. This is an almost universal experience for those with health anxiety, as supported by Asmundson’s (2010) study:
“Other dysfunctional beliefs (eg, viewing the self as weak or vulnerable) may accompany disease conviction and together with preoccupation and worry about the cause and authenticity of bodily sensations and changes, motivate maladaptive coping behaviors. Reassurance seeking (ie, wanting affirmation from others that there is nothing physically wrong) and recurrent checking (eg, repeated palpation of internal lumps or external abrasions, searching the Internet for information about dreaded diseases) serve to perpetuate the belief that benign bodily sensations and changes are caused by disease.” (p. 306)
Since health anxiety causes someone to perceive bodily sensations as potentially more harmful or dangerous, they are often driven to ask others if what they are perceiving is normal in an attempt to alleviate that constant anxiety. Even a benign sensation such as a lump in my throat would become something for me to obsess over, unable to focus on anything else until I asked my parents repeatedly if it was a normal thing to feel.
Obsession is another large part of health anxiety. Similar to panic disorder and obsessive compulsive disorder, health anxiety can cause worried thoughts that never seem to end. “..symptoms of hypochondriasis—at both a topographical and functional level—overlap remarkably with those of certain anxiety disorders, namely panic disorder and obsessive-compulsive disorder (OCD).” (Asmundson, 2010, p. 307) I would experience what I call “runaround thoughts,” where I would be focused on a particular bodily sensation – a pain in my side, for example – and my mind would essentially get stuck in a loop, unable to think of anything else besides the sensation and its possible causes. “Like OCD, hypochondriasis involves intrusive, distressing thoughts and repetitive behaviors.” (Asmundson, 2010, p. 306) While I experienced less of the compulsions, it’s not hard to see why frequent handwashing is a common symptom among those with OCD and hypochondriasis. The possible causes in my mind, however, would be much more severe than someone without health anxiety. A headache could mean a brain tumor, a chest pain could mean a heart attack. This is what is known as catastrophic thinking in psychology. “Ellis (1962) described ‘catastrophizing’ as the tendency to magnify a perceived threat and overestimate the seriousness of its potential consequences.” (Resham, 2016, p. 441) This is a common thought distortion, and I will touch more on that later.
Sometimes, the runaround thoughts would get so catastrophic that I would throw myself into a full blown panic attack. For those who have experienced panic, it can be hard to differentiate symptoms of an attack from real illness. Often, they feel very similar to a heart attack. Everyone experiences different symptoms – however, in my case, I would begin to feel hot, burning sensations on my back and in my extremities. This would be followed by a racing heart, tingling and tightness in the chest, and even lightheadedness. Not exactly comforting for someone who is already anxious about their health.
I remember one of my first panic attacks from when I was very little. I was at a summer camp with my childhood best friend, and we had finished a day-long hiking trip and were spending the night sleeping under the stars in only our sleeping bags on top of a wooden platform. It should have been a beautiful night of stargazing, but my mind had other ideas. Anxious about sleeping out in the open and the large bug I had found in my sleeping bag minutes before, I tossed and turned. Soon, I began to notice a burning sensation making its way up and down my back. Panicking and convinced I was being bit by bugs, I raced to two of the camp counselors, who promptly raised my shirt and checked my back, only to find nothing. I ended up making it through the night, but began to realize that the burning sensation I had experienced was a hallmark indication of panic. Everyone has their own, but knowing mine has helped me differentiate a real health problem from a panic attack that will be over in a few minutes.
Everyone has their own fears that cause them to panic. I definitely have a lot of them. But how do we acquire these fears? “There are three pathways to the acquisition of fears. They are acquired by experiencing disturbing or damaging events, by vicarious acquisition (such as a serious illness experienced by a relative or close friend), or by absorbing threatening information” (Rachman, 1990) I have experienced all three. For some examples on vicarious acquisition, my childhood best friend and I had our ears pierced at the same time. When it was time to change them out, I refused for months after I heard that she had passed out from taking out the earrings she was initially pierced with. I have a horrible fear of wasps because my cousin went into anaphylaxis and nearly died from being stung by one. I wouldn’t eat eggs for a long time because one of my good friends was allergic. Vicarious fears are probably the least impactful of the fears in my experience, but they have still left a deep mark. How, though, were they able to leave such deep scarring?
Trauma is often the strongest, and the deepest, cause of fears. Because of one horrible experience I had in my early childhood, I struggled with debilitating health anxiety for most of my life. It’s hard to imagine that a single event can change so much about a person, but both the timing and the severity of the situation make perfect sense to me.
It happened when I was three years old, when a person is beginning to develop their very first memories. I began to complain to my parents frequently about a stomach ache. I cried occasionally, but because of my age there was little else I could do to describe my pain. They sped me to the doctor, but after complaining over again for several days, doctors realized something more must be wrong than a simple stomach bug. Though I remained in high spirits, the pain remained constant. Doctors examined me over and over, but could not find the cause. Some invasive tests were done that I won’t go into, but they were inconclusive.
The pain worsened, and an ice storm was coming to Dallas. In a decision that probably saved my life, a pediatric gastroenterologist named Dr. Brown admitted me to the hospital so that I wouldn’t be stuck at home if my condition worsened. While there, more tests were run until finally, after a CT scan, we had an answer. I had developed appendicitis – worse still, in the time it took to diagnose me, it had ruptured completely. Three year old toddlers do not commonly develop appendicitis. In fact, it’s almost unheard of. Despite my parents being as attentive as possible and getting me care right away, I still remained in pain for days because of the rarity of my affliction.
Luckily, my body had managed to contain the infection for the most part, avoiding any further complications. I was taken in for surgery immediately, and have experienced no related problems since. However, I have felt lasting effects in another part of my body – my mind. Being in indescribable pain for days, having invasive tests done, and having emergency surgery doesn’t tend to have a positive effect on the brain. Trauma is a response that we develop when we go through something distressing. It doesn’t even have to be anything that feels like a super significant event. Any instance where the body and mind are not getting what they need can result in trauma.
After that event, it was not immediately obvious to me or anyone else in my life that much of my anxiety was caused by the trauma of that experience. My very first memories that I can recall are from that hospital visit. None that are painful or uncomfortable, but I have two that I remember well. One was rather happy – it was when a childhood friend and her family brought me a gingerbread house when I was in recovery. I can still recall how big it was, at least in my three year old memory. The other one is a bit darker. I remember laying on a cot in a small room, several tissues with splotches of my blood scattered around me. I don’t remember exactly what it was from, but I would guess it was from having an IV put in. (Quite poorly too, it seems.) I remember the nurse bending down to reach into a cabinet on the other side of the room and retrieving a plastic bath toy in the shape of a fish, which I kept for quite a while afterwards. These memories are not upsetting to recall, though writing this does make me a bit uncomfortable, but they show that the impact of the event is still fresh in my brain twenty one years later.
The last pathway to the acquisition of fears is through absorbing threatening information. I know I am not alone when I admit that I have spent many hours researching symptoms online hoping to relieve my anxiety, only to perpetuate it and make it worse. WebMD is not exactly reassuring when it comes to health anxiety. The internet contains things that will set off a multitude of anxieties. I notice that when I spend time reading distressing news headlines, scrolling through social media, and have access to looking up symptoms, my mental health takes a dive, and my anxiety increases. I have noticed this most on the platform TikTok, which I now try to avoid as often as I can. It’s naturally a very addictive app, which is a whole other can of worms, but its video format leaves lots of opportunity for people to tell their stories, true or not. Sometimes, such a video would come across my For You page, a section of the app that uses an algorithm to curate a constant stream of content tailored specifically for you. People would recount a time they were seriously ill, even going as far as to list their symptoms and treatment. I had to stop myself from watching videos on TikTok because these videos would trigger me significantly, giving me new fears that I shouldn’t spend my time worrying about in the first place. It seems to have this effect on other people as well, and I believe that it’s incredibly detrimental to our mental health to keep consuming that kind of content.
Health anxiety still affects me almost daily. Though it has improved immensely through a great amount of hard work and perseverance, I still feel it rear its head sometimes. I think I always will. Only a few years ago, before the pandemic, I went on a week-long anxiety bender where I was convinced that something was wrong with my heart. I was at a point in my life where I was not taking proper care of myself. My depression and stress were the worst they had ever been. I was experiencing lots of anxiety, which already makes you feel strange, accompanied by what felt like heart palpitations because I wasn’t eating properly. It became so extreme that I booked an appointment with a local cardiologist, and wore an EKG for seventy-two hours. After all that effort, when my results finally came back, they found nothing wrong. My heart was perfectly fine. I was so bent on searching for something to focus my anxiety on, that I almost completely disregarded logic. Anxiety has a way of making you jump to the worst-case scenario, and if left unchecked, can take over your life if you let it.
The good news is that there is help available. I myself have been through almost all types of modern therapy, and was able to get a handle on my mental health again. Surprisingly, however, there isn’t much research out there about health anxiety specifically. “One explanation for the lack of research on health anxiety is that psychometrically sound measures of this construct have not been available. Recently, however, Salkovskis, Rimes, Warwick, and Clark (2002)introduced the Health Anxiety Inventory (HAI) and its abbreviated form, the Short HAI (SHAI).” (Abramowitz, 2007, p.86) Health anxiety has however become easier to identify, and there is ongoing research as to which types of therapy are most effective to tackle it. Regardless, through therapy, my health anxiety is one of the aspects that I have worked on that has improved the most. Our modern therapy practices are fit to deal with health anxiety, it’s just the daunting matter of choosing one.
There are many different approaches to therapy– if you find that one doesn’t work for you, it is likely that another will work better. One of the first ones I tried was Acceptance and Commitment Therapy, or ACT. The main focus of this type of therapy is to accept our painful feelings. “Defusion and acceptance are about separating from thoughts and feelings, seeing them for what they truly are, making room for them, and allowing them to come and go of their own accord.” (Harris, 2020, p. 22) I participated in this type of therapy shortly after the episode with my heart as part of an Intensive Outpatient Program (IOP.) We met four times a week, and focused on learning techniques to accept painful feelings and self-regulate. While these techniques were helpful, I found that for me they weren’t the most effective at the time.
The two main types of therapy that I still participate in are Cognitive Behavioral Therapy (CBT), and a branch of CBT, Dialectical Behavior Therapy (DBT.) Cognitive Behavioral Therapy begins with recognizing that some of our thoughts are distorted. There are many distortions, and I mentioned one earlier – Catastrophic thinking, immediately leaping to the worst-case scenario. CBT aims to help us challenge and rewire our thoughts once we learn to recognize these distortions. Since I had trouble reigning in the catastrophic thoughts, I focused on stopping, examining the thought and whether or not it was helpful. Most of the time, such thoughts are not rooted in reality. Could this headache really be a brain tumor? Statistically and logically speaking, no. And such a thought isn’t doing me any good. It’s a product of my anxious mind, still worried that I will likely have something horribly wrong with me and no one will recognize it, just like when I was three years old with appendicitis.
DBT is in the same family as CBT, delving into much of the same techniques except with a focus on mindfulness and emotional regulation. It’s more about learning to sit with those painful feelings, realizing that they aren’t going to kill you, and learning how to take steps to make yourself feel better. Self care is a big part of this one. CBT and subsequently DBT have been proven to be quite effective for anxiety disorders. “Cognitive behavioral therapy (CBT) has been shown to be highly effective in the treatment of health anxiety. However, little is known about the effectiveness of group CBT in the treatment of health anxiety.” (Weck, 2015, p. 2) They have worked very well for me, though I have been in nearly continuous therapy for several years. I like being able to sit down with someone knowledgeable about my history and talk through my thoughts with them, examining where those thoughts come from so that I can learn to let them go if they are not helpful.
The final type of therapy that I will talk about here has been instrumental in tackling my trauma. It’s an odd one – Eye Movement Desensitization and Reprocessing (EMDR.) This type of therapy is specifically for traumatic memories, and makes use of the same process that happens every time we sleep. You might be familiar with the period of sleep called REM, or rapid eye movement. This is a period when our brains are consolidating memories from our day, cementing knowledge and cleaning the slate for the next day. In a similar way, EMDR allows us to reach back into the traumatic memories, which may not even be immediately accessible. We can examine the event and the feelings that come up, allowing us to reformulate negative beliefs caused by that trauma.
In my experience, it begins with picking a memory associated with the trauma. Then, a licensed therapist begins holding up a finger and moving it side to side at medium speed, having you follow it with your eyes while thinking about the memory. This only lasts about fifteen seconds at a time. After they stop moving their finger, the therapist pauses and asks you to tell them what thoughts or feelings came up for you during those fifteen seconds. After writing down what came up, they go right back to having you follow their finger – rinse and repeat. It’s like following a trail of breadcrumbs, beginning with a memory and seeing where the thoughts lead you.
I have had some breakthroughs and emotional realizations doing this. While it leaves me feeling incredibly drained afterwards, it has been incredibly helpful in alleviating pain caused by my many traumas. EMDR also works very well hand in hand with CBT. “Because cognitive behavioral therapy (CBT) is presently considered a first-line treatment for anxiety disorders, controlled comparisons between EMDR therapy and CBT would be especially useful in future investigations of EMDR treatment of anxiety disorders.” (Faretta, 2019, p. 325) Putting these two therapies together is potentially a very effective combination. It depends on the person, but participating in both of these therapies together has yielded great progress for me.
There are so many types of therapy out there, there’s bound to be one that will work for you. I will not lie, it takes a tremendous amount of work and commitment. I even went so far as to subject myself to a three month therapy program in the woods. It was the hardest thing I have ever done, but it taught me how to work hard again, how to get a handle on my emotions, and how to feel content again. I’ve found that a mix of all the mentioned therapies has worked well for me, but it’s very different for everyone. There are even more down to earth approaches, such as meditation, yoga, and acupuncture that have worked for many people who struggle to tame their thoughts. I hope that my account helps someone who may be struggling with health anxiety, and inspires them to seek help if they need it. There are so many resources available to you.
Though my health anxiety has been a burden for much of my life, I don’t think I would wish it away. Even though it sometimes drove me into a panic, it has now led me on this incredible journey of self discovery and growth. I would not be who I am today without it. It has encouraged me to look deeply into my own mind and learn things about myself that I would never have known otherwise. It has taught me that pain and hardship are chances to grow. So, even though my appendix burst at age three and left more scarring than just from surgery, it has led me to wonderful things. From finding myself through therapy to meeting Dr. Phil in the hospital after my operation, sometimes good things come from pain. We just have to accept the uncomfortable parts and commit to living the fullest lives that we can.
References
Jonathan S. Abramowitz, Bunmi O. Olatunji, Brett J. Deacon, Health Anxiety, Hypochondriasis, and the Anxiety Disorders, Behavior Therapy, Volume 38, Issue 1,
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Faretta, Elisa, and Mariella Dal Farra. “Efficacy of EMDR Therapy for Anxiety Disorders.” Journal of EMDR Practice and Research, vol. 13, no. 4, 2019, pp. 325–332., https://doi.org/10.1891/1933-3196.13.4.325. Accessed 2022.
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